Provider Demographics
NPI:1447389002
Name:HECTOR M RODRIGUEZ DO PC
Entity type:Organization
Organization Name:HECTOR M RODRIGUEZ DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RYBLOOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-977-9838
Mailing Address - Street 1:1820 SW VERMONT ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-1945
Mailing Address - Country:US
Mailing Address - Phone:503-977-9838
Mailing Address - Fax:503-977-9624
Practice Address - Street 1:1820 SW VERMONT ST
Practice Address - Street 2:SUITE A
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-1945
Practice Address - Country:US
Practice Address - Phone:503-977-9838
Practice Address - Fax:503-977-9624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO17335207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR118007Medicare PIN